Public health responses to obesity in the United Kingdom: A critical evaluation of campaigns and policy directions (1990–2025)

Öz

Obesity, defined by the World Health Organisation as excessive fat accumulation impairing health, has become a major global public health issue. By 2022, one in eight people worldwide were living with obesity, a figure projected to rise to one in four by 2035. The United Kingdom (UK) mirrors these trends, with obesity rates continuing to escalate, particularly among children. This ethnographic study explores obesity prevention strategies and health communication campaigns in the UK from 1990 to 2025, combining policy analysis with in-depth interviews with 35 adults across the UK. Findings indicate that the implemented campaigns have been effective in raising public awareness; however, their impact has neither been equitably distributed across different segments of society nor sustained over the long term. Although obesity prevention policies and campaigns implemented in the UK have, at times, demonstrated innovation and contributed to raising public awareness, these strategies have predominantly centred on behavioural change, while social policies and regulatory measures capable of addressing structural inequalities have been largely neglected. The study concludes that effective obesity prevention requires not only behavioural messaging but also long-term, equity-oriented policy reform that addresses social determinants and holds commercial actors accountable.

Anahtar Kelimeler

• Obesity
• health strategies
• policy
• campaigns
• UK

Birleşik Krallık’ta obeziteye yönelik halk sağlığı yaklaşımları: 1990-2025 Kampanya ve politika yönelimlerinin eleştirel değerlendirmesi

Öz

Dünya Sağlık Örgütü tarafından sağlığı bozacak şekilde aşırı yağ birikimi olarak tanımlanan obezite, küresel ölçekte önemli bir halk sağlığı sorunu haline gelmiştir. 2022 itibarıyla dünya genelinde her sekiz kişiden biri obeziteyle yaşamaktadır ve bu oranın 2035 yılına kadar her dört kişiden birine yükselmesi öngörülmektedir. Birleşik Krallık da bu eğilimleri yansıtmakta; özellikle çocuklar arasında obezite oranları artmaya devam etmektedir. Bu etnografik çalışma, 1990’dan 2025’e kadar Birleşik Krallık’taki obeziteyi önleme stratejilerini ve (bu stratejiler doğrultusunda belirlenen hedeflere ulaşmak için yürütülen) sağlık iletişimi kampanyalarını incelemekte; politika analizini Birleşik Krallık genelinde 35 yetişkinle yapılan derinlemesine görüşmelerle birleştirmektedir. Bulgular, uygulanan kampanyaların kamu farkındalığını artırmada etkili olduğunu; ancak bu etkinin toplumun farklı kesimlerine eşit şekilde dağılmadığını ve uzun vadede sürdürülemediğini ortaya koymaktadır. Birleşik Krallık’ta uygulanan obeziteyle mücadele politikaları ve kampanyalar, belirli dönemlerde yenilikçi ve toplumsal farkındalığı artırıcı nitelikler taşısa da bu stratejiler genellikle davranışsal değişimi merkeze almış; yapısal eşitsizlikleri dönüştürecek sosyal politikalar ve düzenleyici önlemler geri planda bırakılmıştır. Çalışma, etkili obeziteyle mücadelenin yalnızca davranışsal mesajlarla sınırlı kalmayıp; sosyal belirleyicileri ele alan ve ticari aktörleri sorumlu tutan uzun vadeli, eşitlik odaklı politika reformlarını da gerektirdiği sonucuna varmaktadır.

Anahtar Kelimeler

• Obezite
• sağlık stratejileri
• politikalar
• kampanyalar
• Birleşik Krallık

Kaynakça

1. Ata R.N., & Thompson J.K. (2010). Weight bias in the media: A review of recent research Obesity Facts, 3(1):41-46. https://doi.org/10.1159/000276547google scholar
2. Bailey, Z. D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the United States: Evidence and interventions The Lancet, 389(10077), 1453–1463. Doi: 10.1016/S0140-6736(17)30569-X google scholar
3. Bernard, H. R. (2013). Social research methods: Qualitative and quantitative approaches. SAGE Publications. google scholar
4. Butland B, Jebb S, Kopelman P, Foresight Obesity System Map Working Group. (2007). Tackling obesities: Future choices—project report Government Office for Science. https://www.thetimes.co.uk/article/nanny-state-fears-hinder-battle-against-obese-britain-0zqqdqv7s?utm_source=chatgpt.comgoogle scholar
5. Cairns, G., Angus, K., Hastings, G., & Caraher, M. (2013). Systematic reviews of the evidence on the nature, extent, and effects of food marketing to children. A retrospective summary. Appetite, 62:209-215. doi: 10.1016/j.appet.2012.04.017 (Epub May 2, 2012 PMID: 22561190) google scholar
6. Charmaz, K. (2014). Constructing grounded theory (2nd ed.). SAGE Publications. google scholar
7. Cobiac, L.J., Rogers, N.T., Adams, J., Cummins, S., Smith, R., Mytton, O., White, M., & Scarborough, P. (2024). Impact of the UK soft drinks industry levy on health and health inequalities in children and adolescents in England: An interrupted time series analysis and population health modelling study. PLoS Medicine, 21(3):e1004371. doi: 10.1371/journal.pmed.1004371. PMID: 38547319; PMCID: PMC11008889.google scholar
8. Creswell, J. W. and Poth, C. N. (2018). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). SAGE Publications.google scholar

9. Croker, H., Lucas, R. & Wardle, J. (2012). Cluster-randomised trial to evaluate the ‘Change for Life’ mass media/social marketing campaign in the UK. BMC Public Health, 12, 404. https://doi.org/10.1186/1471-2458-12-404 google scholar
10. Collins, E., Beattie, A., Ramagopalan, S. V., & Pearson-Stuttard, J. (2024). First in class, best in class, or a wild card: Who will dominate the anti-obesity medication market? Journal of Comparative Effectiveness Research, 13(7), e240044. DOI: 10.57264/cer-2024-0044 google scholar
11. Darmon, N., & Drewnowski, A. (2008). Does social class predict diet quality? The American Journal of Clinical Nutrition, 87(5), 1107–1117. DOI:, [10.1093/ajcn/87.5.1107] google scholar
12. Department of Health and Social Care. (2020). Tackling obesity: Empowering adults and children to live healthier lives. HM Government. e435. https://doi.org/10.1016/S2468-2667(21)00070-7 google scholar
13. Department of Health. (2004). Choosing Health: Making Healthy Choices Easier (White Paper) The Stationery Office. google scholar
14. Department of Health. (2011). Change4Life: Three-year social marketing strategy. UK Government. google scholar
15. Department of Health and Social Care. (2013). Front-of-pack nutrition labelling in the UK. GOV.UK. google scholar
16. Evans J, Rich E, Davies, B., & Allwood, R. (2008). Education, disordered eating and obesity discourse: Fat fabrications. Educational Studies, 34(2), 179–191. google scholar
17. Fenton, K. (2016). One You: A step towards better health and more sustainable services. UK Health Security Agency. https://ukhsa.blog.gov.uk/2016/03/07/one-you-a-step-towards-better-health-and-more-sustainable-services/google scholar
18. Flint, S. W., and S. Reale. 2014. Obesity stigmatisation from researchers on obesity. The Lancet, 384(9958), 1925-1926. google scholar
19. Flint, S.W., Hudson, J. Lavallee, D. (2015). UK adults’ implicit and explicit attitudes towards obesity: a cross-sectional study. BMC Obesity, 2, 31.google scholar
20. Flint, S. W., Snook, J., & Hudson, J. (2015). The portrayal of obesity in UK national newspapers: public discourse and representation Stigma and Health, 1, 16-28. google scholar
21. Flint, S. W., & Nobles, J. (2018). Weight stigma and discrimination: A call to the media. The Lancet Diabetes Endocrinol, 6(3), 169-170. google scholar
22. Government Office for Science & Department of Health and Social Care. (2007–2011). Tackling obesities: Future choices [Report collection]. UK Government. https://www.gov.uk/government/collections/tackling-obesities-future-choicesgoogle scholar
23. Halford J.C.G., Brown, A., Clare, K, et al (2024) Insights from the ACTION Teens Study: A survey of adolescents living with obesity, their caregivers and healthcare professionals in the UK. BMJ Open,14: e086391. https://doi.org/10.1016/j.bmjopen.2024.08.086. google scholar
24. Hammersley, M., & Atkinson, P. (2007). Ethnography: Principles in practice (3rd ed.). London: Oxford University Press. Routledge. google scholar
25. Link, B. G., & Phelan, J. (2001). Conceptualising stigma. Annual Review of Sociology, 27, 363–385. doi: 10.1146/annurev.soc.27.1.363 google scholar
26. Lupton, D. (1995). Health imperative: Public health and the regulated body. SAGE. google scholar
27. Main, J. A., & Main, P. G. (1992). Health of the nation. BMJ (Clinical research ed.), 305(6849), 362. https://doi.org/10.1136/bmj.305.6849.362 google scholar
28. Marmot, M. (2010). Fair society and healthy lives: The Marmot Review. Institute of Health Equity. google scholar
29. Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365(9464):1099-1104. doi: 10.1016/S0140-6736(05)71146-6. PMID: 15781105.google scholar
30. Michalopoulou S., Sifaki, M., Packer, J. et al (2024). Assessing the impact of obesity interventions in the early years: A systematic review of UK-based studies. BMJ Open, 14, e076479. google scholar
31. Monteiro, C. A., Moubarac, J.-C., Cannon, G., Ng, S. W., & Popkin, B. (2013). Ultra‐processed products are becoming dominant in the global food system. Obesity Reviews, 14 (Suppl 2), 21–28. https://doi.org/10.1111/obr.12107google scholar
32. Morgan, K., & Sonnino, R. (2008). The School Food Revolution: Public Food and the Challenge of Sustainable Development, 1st ed. Routledge. https://doi.org/10.4324/9781849773256 google scholar
33. Morse, J. M. (1994). Designing the funded qualitative research. In Denzin and Lincoln (Eds.). Handbook of qualitative research. Sage. google scholar
34. Nazroo, J. Y., Bhui, K. S., & Rhodes, J. (2020). Where to go next for understanding race/ethnic inequalities in patients with severe mental illness? Structural, Interpersonal, and Institutional Racism Sociology of Health & Illness, 42(2), 262–276. https://doi.org/10.1111/1467-9566.13001https://doi.org/10.1111/1467-9566.13001google scholar
35. NHS Digital. (2023). Health Survey for England, 2022 NHS Digital. google scholar
36. Popay, J., Williams, G., Thomas, C. and Gatrell, A. (2003). Theorising health inequalities: The place of lay knowledge Sociology of Health and Illness, 25(3), 396-414. google scholar
37. Public Accounts Committee. (2023a). Obesity policy in England. UK Parliament. https://publications.parliament.uk google scholar
38. Public Accounts Committee. (2003b). Tackling obesity: The Public Accounts. UK Parliament. Available from: https://committees.parliament.uk/publications/ google scholar
39. Public Health England. (2016). Change4Life campaign review. London: Public Health England. google scholar
40. Public Health England. (2017). Health matters: Obesity and the food environment. PHE Publications Gateway number: 2020-117. google scholar
41. Public Health England. (2021). NHS Weight Loss Plan: Better health campaign evaluation report. London: Public Health England. google scholar
42. Puhl, R. M. and Heuer, C. A. (2009). Obesity stigma: A review and update Obesity, 17(5), 941-964. google scholar
43. Roberto, C. A., Swinburn, B., Hawkes, C., Huang, T. T. K., Costa, S. A., Ashe, M., Zwicker, L., Cawley, J. H., & Brownell, K. D. (2015). Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking The Lancet, 385(9985), 2400–2409. DOI: 10.1016/S0140-6736(14)61744-X google scholar
44. Safefood. (2022). Many in NI support policies to combat obesity. Retrieved from https://www.safefood.net/news/obesity-policies-ni google scholar
45. Swinburn, B. A., Kraak, V. I., Allender, S., Atkins, V. J., Baker, P. I., Bogard, J. R. & Dietz, W. H. (2019). The global syndemic of obesity, undernutrition, and climate change: The lancet commission report. The Lancet, 393(10173), 791–846. DOI: 10.1016/S0140-6736(18)32822-8 google scholar
46. Teng, A. M., Jones, A. C., Mizdrak, A., Signal, L., Genç, M., & Wilson, N. (2019). Impact of sugar-sweetened beverage taxes on purchases and dietary intake: Systematic review and meta-analysis. Obesity Reviews, 20(9), 1187–1204. https://doi.org/10.1111/obr.12868 google scholar
47. Theis, S., & White, M. (2021). Is England’s obesity policy fit for purpose? Analysis of government strategies and policies, 1992–2020. The Lancet Public Health, 6(9), e655–e666. https://doi.org/10.1016/S2468-2667(21)00168-4 google scholar
48. Wardle, J., Waller, J., & Jarvis, M. J. (2002). Sex differences in the association between socioeconomic status and obesity American Journal of Public Health, 92(8), 1299-1304. google scholar
49. World Health Organisation. (2023). Obesity and overweight: Key facts. Retrieved from https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweightgoogle scholar
50. World Health Organisation. (2010). A conceptual framework for action on the social determinants of health. Social determinants of health discussion paper 2 (Policy and practice). World Health Organization.google scholar
51. World Obesity Federation. (2024). World Obesity Atlas 2024. https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2024google scholar